Use of Mobile Technology with Undergraduate Nursing Students

Concurrent Session 3

Session Materials

Brief Abstract

In a first-semester undergraduate blended nursing health assessment course, smartphone/tablet apps were introduced.  These open-educational resource apps allowed the students to perform health risk stratification assessment.   The apps were then used as part of regularly scheduled community screenings. Evidence-based literature was used when counseling patients regarding individual results.


Dr. DeCristofaro is a graduate of Hunter College of CUNY in New York City, where she majored in Biology/Chemistry and minored in Math/Psychology as a Thomas Hunter Honors Scholar. She then attended Albert Einstein College of Medicine, in the Bronx, NY. Her family practice has been in urban (inner city) New York City, rural Tennessee and South Carolina, and now the free-clinic setting in SC. Her academic appointments have been as traditional and distance educator faculty positions in NY, SC, NC, IL, PA and CA teaching in BSN, MSN/DNP (FNP, PNP, Nurse Anesthesia), PA and Behavioral Science/Psychology programs. In addition to serving as a clinical preceptor for graduate healthcare students, her university courses have included Advanced Pathophysiology & Physiology, Advanced Pharmacology, Clinical Laboratory & Imaging Diagnostics, Advanced Physical/Health Assessment, BSN Pharmacology, BSN Pathophysiology, Pediatrics, Community & Preventive Health, and Psychology courses. She regularly authors Continuing Education for nurses/APRNs, PAs and pharmacists, in both the live conference setting as well as online with Upstate AHEC in SC and is a federal grant reviewer for the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to clinical research and scholarship publications, her academic interests include the scholarship of teaching and learning (SoTL) and she has served as an eLearning Faculty Fellow and presentations at OLC (Sloan-C) have included a peer review Online Course Assessment Tool and work on inter-rater reliability in online faculty peer review. Other SoTL projects have been presented at the CIDER CHEP conference at Virginia Tech, the International Journal of Arts and Sciences conference (Harvard) and the Teaching Professor conferences.. Other SoTL topics in journal publications and conferences have included topics on strategies to support communication within the clinical multidisciplinary team, blending technology in the classroom (simulation and hand-held smartphone/tablet clinical software), using online communities in graduate nursing education, increasing student engagement using the online discussion board, peer review training, and flipping the classroom. Clinical publications have included clinical case studies as well as review and research articles on a variety of clinical topics (smoking cessation, diagnostics for HPV, anesthesia emergence agitation, childhood obesity, traumatic brain injury, sucrose analgesia, use of long-acting contraceptives in the public health setting). CE topics have included Controlled Substance prescribing, pain management, diabetes, hypertension, irritable bowel syndrome, overactive bladder syndrome, dyslipidemia, complementary/alternative medicine, dementia, safe practice and more.

Additional Authors

Tracy George is an assistant professor of nursing at Francis Marion University. She graduated from Davidson College with a Bachelor of Science in Biology. She completed undergraduate nursing coursework and a Master of Science in Nursing from Vanderbilt University School of Nursing in 1999. During her time at Vanderbilt, she received the Luther Christman Award for Clinical Excellence. In 2014, she graduated from the doctor of nursing practice (DNP) program at the Medical University of South Carolina. She became a certified nurse educator in 2014. Tracy has worked as a family nurse practitioner since 1999 in Georgia, North Carolina, and South Carolina. Tracy continues to work one day per week at the South Carolina Department of Health and Environmental Control as a nurse practitioner, and she is a volunteer nurse practitioner with the Dillon County Free Medical Clinic. Since 2012, Tracy has taught undergraduate and graduate nursing courses at Francis Marion University. She has presented statewide and nationally on nursing and nursing education topics, including testing in nursing, the use of smartphones among nursing students, and long-acting reversible contraception (LARCs) and shared decision-making. Tracy has written nine peer-reviewed articles and two textbook chapters. She is the school garden coordinator at Latta Elementary School and a member of the advisory board of Carolinas Rehabilitation Hospital. She is the co-coordinator of the Francis Marion University Nursing Alumni group and is the Vice-President of Francis Marion University’s Chi Lambda Chapter of Sigma Theta Tau International.

Extended Abstract

Background:   It is important for nursing students to become comfortable with accessing point of care (POC) technology to support provision of safe, evidence-based care to patients.  Textbooks and reference guides can be bulky to carry in the classroom and clinical settings, and they become outdated quickly.  Health care is rapidly changing, and nursing students need to access up-to-date reference materials and clinical practice guidelines in order to provide safe, high-quality care to patients. Nurses in practice frequently access clinical resources via their smartphones, such as information about drug therapies.  Educational innovations that support this proficiency will prepare students to become nurses who are better prepared to provide safe, current, and evidence-based care to patients.

The purpose of this educational innovation was to implement the use of smartphone technology in a variety of learning activities in an undergraduate health assessment course.  Earlier nursing education research focused more on personal digital assistants (PDAs), but smartphones are becoming more prevalent in today’s American society.   Many traditional prelicensure nursing students are less than thirty years of age, and most of them already use smartphones on a daily basis.  In the clinical educational setting, utilization of smartphones for texting can enhance real-time communication with preceptors and instructors.  Safe care is also supported by the ability to access internet resources, including videos, podcasts, practice guidelines, and pharmacology resources.

  Expanding to the community setting, smartphone applications (apps) and internet access can support application of health promotion knowledge in the field, providing resources to substantiate and endorse recommended patient screenings.  There is a need for greater integration of mobile technology into the classroom and laboratory, and assignments such as case studies and group projects that require the use of apps allow students to become more familiar with the capabilities of mobile technology.   The utilization of apps in the classroom also promotes facility with their use, and may promote more consistent and accurate use in the clinical setting.  Incorporating technology into the classroom can be challenging, requiring the educator to achieve competency with software applications and devices before including it into the curricula; however, faculty training with the devices and software enables successful role-modeling in laboratory practice sessions.

Methods: Smartphone applications (apps) were introduced into community screening settings in a first-semester blended undergraduate nursing health assessment course. The apps provided information about body mass index (BMI) as well as United States Preventive Services Task Force (USPSTF) recommended preventive services using the Agency for Health Research and Quality (AHRQ) electronic preventive services selector (ePSS) app.  Classroom activities prepared students using mock cases and real data, and evidence-based guidelines were used when counseling patients regarding individual results.  Faculty planning included identifying teaching strategies and goals, investigating the availability of health promotion smartphone apps, testing these on Android and iPhone smartphones, and selecting the apps that most closely aligned course and program outcomes. Once smartphone apps were selected, faculty developed the learning materials for laboratory use, as well as the screening event packets.  This investment of faculty time was separate from normal teaching duties and took place several months prior to the beginning of the semester. 

Expanding beyond the confines of using smartphone apps in this course’s learning activities, the experience of using the BMI and ePSS apps prompted students to actively search for additional apps that would be helpful in nursing practice.  Many students shared which apps they found useful with classmates, instructors, and nursing preceptors.  The authors were gratified to learn that as a consequence of our BSN students sharing their positive experience with practicing nurses in the community, many then began to also use these and other apps in their own practice.  These professional nurses were impressed with the benefit obtained by using smartphone apps, and with the ready acceptance of this technology by patients.

Results:  This educational innovation aligned with both course- and program-specific learning outcomes in order to promote optimal learning by students.  Course-specific outcomes included integration of knowledge from the sciences to conduct a thorough health history, the ability to advocate for health promotion and disease prevention at the individual and population level by performing risk assessments, and the analysis of assessment data and evidence-based knowledge to develop interview strategies.  Program-specific outcomes had an emphasis on health promotion, informatics, and evidence based practice. 

Smartphone apps were well-accepted by students and allowed students to transfer learning from the classroom and laboratory to the community setting.  The use of the BMI and ePSS apps assisted the students to become more familiar in general with the use of apps in nursing practice.  The use of the ePSS app assisted students to improve their history taking skills, since using the apps during community screenings required students to specifically ask about the patient’s age, gender, smoking status, pregnancy status, and sexual activity in order to obtain the ePSS recommendations. 

Conclusion:    Smartphone apps are already familiar to most nursing students, and incorporation of POC technology supported both course and program outcomes.  Using the apps engaged students in the laboratory, helped with subject content recall, and with the development of interview skills.  Students viewed the apps as both more convenient than textbooks and as an entertaining way to learn.  Due to the existence of many free clinical and reference apps, a financial burden is not a barrier to use.  Using the apps allowed students to translate learning from the classroom and laboratory into the experiential setting, and was instrumental in supporting a positive community impact on health promotion and disease prevention.  An unintended benefit is demonstrating that nurses provide leadership for health promotion, disease prevention and achieving health equity in the community.  Overall, smartphone apps promote active learning and the long-term retention of knowledge.  In addition, this community-based activity supports the validity of independent health promotion activities in nursing practice.  The authors conclude that capitalizing on the learning strategy of using smartphone apps in the classroom or laboratory as well as in the clinical setting will better engage students in active learning and promote long-term retention of nursing content.